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Good morning,

I am deeply curious about the efficacy of use of biopsies to diagnose and confirm vulvar Lichen Sclerosus.

Many including myself were diagnosed solely by clinical examination and told it was a clear case of Lichen Sclerosus and that no biopsy was needed.

However, it seems that ideally, everyone would be biopsied to confirm, and further, that this would be done BEFORE any steroid treatment so as not to mask any results for the lab technicians.

What is the best practice with respect to diagnosing LS? Should biopsies always be done instead of relying on clinical examination? What about those of us who were never biopsied but have been on long-term steroid use and no official documentation of the LS diagnosis via biopsy?

Also, how effective are biopsies in confirming and diagnosing LS. Can you point me in the direction of medical literature discussing the efficacy and potential problems with biopsies and LS diagnoses? Is it possible that if it's too early a biopsy could give a negative result? How soon should a patient be biopsied?

Thank you for your questions. In my opinion vulvar Lichen Sclerosus should be biopsied to confirm diagnosis. Biopsies are usually reliable in this condition.

I hope this is helpful.
Best wishes,
Dr Anton Alexandroff
Consultant Dermatologist, Honorary Senior Lecturer & BSF spokesperson - FRCP, CCT (Derm), PhD, FRSM, FAAD
www.alexandroff.org.uk